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HomeMy WebLinkAbout2018-497-E Finance - Historical Foundation of Hillsborough and OC outside agency agreementDocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2018, ( "Effective Date ") by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ( "County ") and Historical Foundation of Hillsborough and Orange County, a not - for -profit corporation, located at 201 N. Churton Street, Hillsborough, NC 27278 ( "Provider "). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Historical Foundation of Hillsborough and Orange County agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2018 to June 30, 2019. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of $9,606. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of $2,401.50. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. (Historical Foundation of Hillsborough and Orange County) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 — December 31; January 1 — March 31 and April 1 - June 30. Reports are due on January 11, April 12, and July 12 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default "), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten (10) business days from written notice of default. The County may (but shall not be required to) grant the (Historical Foundation of Hillsborough and Orange County) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof, iii. Comprehensive Automobile Liability Insurance, including hired and non -owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation • Commercial General Liability • Automobile Liability • Professional Liability Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee $1,000,000 Each Occurrence $2,000,000 Aggregate $500,000 Combined Single Limit $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 (Historical Foundation of Hillsborough and Orange County) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non - Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non - Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 14.25 per hour. To the extent possible, Orange County recommends that Historical Foundation of Hillsborough and Orange County provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices (Historical Foundation of Hillsborough and Orange County) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Historical Foundation of Hillsborough and Orange County 201 N. Churton Street Hillsborough, NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147 - 86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article I IA and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For - oacuSigned by: - - �ovider 5ft,f�t. PV'r w 2AC3FKE31E241. F... For and docusignedby: - J Pz ty Government EE0637994B755E477... Bonnie Hammersley, County Manager (Historical Foundation of Hillsborough and Orange County) Orange County Outside Agency Performance Agreement Rev. 7118 8/16/2018 Date 8/18/2018 Date Page S of 9 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact I Fdom-liakion Applicant Organization's Legal Name- The Hrstoric2I Foundation of Hillsborough Orange County Applicant Oroaniz tion's PhysiQall Address: 201 Ncra,� Churtr)n St., Hillsborough. NC 27278 Applicant Organizafion's Mailing Address 201 Hodh Churton St., Hillsbcr-ourgl7, NC 27278 ApPii w t Organization's Web Address- €Lr.a iaLnohrstory.or_q Executive Director: Stephanre F'ryp Telephone Numbs (919) 732 -2201 E -Mail: direclor@ci.--angenchi�tor-y.org Tax lb Number: 6M797289 b) Funding Request List all FY'18 -19 Human Servires tHS1 Funding Being Requested — Fw All Pro rams and the Proposed Use of Funds (2 -3 limes or lass) Pro-11ram Ey- Youth Afterschool Progr'arn Aftersc'hool Program Coordinator w1aryr and materials iqr outih activities ,and prcijer Oran untyr F- rstwgal Museum-- Education through Exhibits; OutTeaeh EduG- ion: PresarwatiQn aM R i;h (in udes research) T�tal� arrt,�r Ms Hill H $10,000 1 , PQH�__ Total Coup -HS V5,001) $30,000 16 ,388 To the best of my knowledge and belief all information a rr.d data in this application is true an,d current `fhe doh has been-duly authorized by the goveming board of the applicant.' � . Signature, AG Eft CY I NFOR �10 1 1;: r A l Page :8 o f 40 lope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Executive Dig Signature: Board Chairpe Date AGENCY INFORMATION 1 t231201 9 7.02'4; AM P 33 g e 9 G f 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND ICON DISC RIMINATION CLAUSE Are any of the Board Members or employees of the ageroy which will be carrying out this program or membm of their immediate families, or their business associates... YES NO E) X a) Employees of or closely related to employees of ttre Town of Carrboro, the Town of Chapel Hill, or Orange County? El X b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hall, or Orange County? E] X c) Current beneficiaries of the program for which funds are being requested? ® X d) Paid providers of goods of services to the program or having other financial interest it the program? If you have answemd YES to any question, ptbase provide a full explanation Wow. NON - DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials. employees and servants agree riot to discriminate in any manner of these basis of race, color, gender, nadional olrlgin, Ten handicap, religion, sexual orieritation, gender identitylexpression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agme in all respects to conform to the provision and intent of Orange County Civil fights Ordinance„ as amended and the Orange Cou Anti- discrimination Policy. This provision is enforced by action for specific performance. injunctive relief, or othe remedy as by lawn provided; this provision small be Winding on the grantees, the successors and assigns of the parties hereto with refemnoe to the above subject manner. To the bmt of my knowledge and belief all of the above information is tnym and current I acknowledge, and 'undemtantl that the existence of a potential conflict of interest does not necessarily rake the program ineligible for funding, but the existence of an undisclosed conflict t in the termination of a nt_awarded. - Signature: Date Signature, Board ChairpawQV Date AGENCY INFORMATION 2 t i Bt8 1013,36 AM P a g e 10 :) t 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): Orange County Historical Museum, in operation for 58 years, was incorporated in 1983. The Historical Foundation of Hillsborough and Orange County ( HFHOC), incorporated in 2007, has operated OCHM for nine years. OCHM is open six days per week, and offers free admission to visitors. b) Agency's Purpose /Mission (no more than a few sentences): Mission of HFHOC is to enlighten and engage our community and visitors from around the world by preserving and interpreting the history of Orange County. c) Types of Services the Agency Provides (bullet format): • Exhibitions. • Public programs. • Publications. • Preservation of historic artifacts and documents relevant to Orange County history. • Make OCHM archives and collections available to researchers. • Support historic preservation efforts in Orange County. d) Agency's History with Providing These Services: The museum has extensive experience with programs for which we seek FY17 -18 funding: Program 1: Education through Exhibits: 59 years. The Orange County Historical Museum has provided public education through temporary and permanent exhibits for 59 years. From the first exhibits based on Colonial -era English weights and measures and Eno Rive Native American artifacts to a current look at tools of historic Orange County commerce, industry and government, exhibits inform and support museum visitors' understanding of our local history. Program 2: Outreach Education: 60 years. In 1957, the Orange County Historical Museum hosted its first field trip to a class of 7th graders. Museum staff continues to invest significant development and execution time in heritage education programs, at the museum and as outreach in Orange County public schools and the Orange County community. Primary audience: students in grades 1 - 5. Program 3: Preservation and Research: 60 years. The process of collection, preservation, and conservation of significant cultural artifacts supports the design, interpretations, and implementation of exhibits about Orange County history that continue to educate and delight our visitors. The museum offers access to its historic documents and other artifacts to those researching Hillsborough and OC history. Museum staff also provides individualized collections research assistance to support individual and community historical projects. e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year? Is there a new Executive Director? Are there new initiatives ?) Agency Information 1/23/2018 12:14 :22 PM Page 11 of 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION There was a change in Board leadership in the spring of 2017 (Ernest Dollar named new Board Chair). At the end of 2017, the board appointed a new Interim Executive Director. e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year? Is there a new Executive Director? Are there new initiatives ?) f) Schedule of Positions (For Entire Agency) • Full Time Equivalent (FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 2080 # of FTE - Full -Time Paid Positions: .75 # of FTE - Paid Part -Time Positions: .75 # of Volunteers: 20 # of FTE - Volunteers:7 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/ No) No If yes, is this agency an Orange County Living Wage Certified Employer? If no, please explain. The museum is operated by HFHOC to fulfill its mission to enlighten and engage the community and visitors from around the world by preserving and interpreting Hillsborough and OC history. Income sources are primarily endowment grants and proceeds from fundraising activities. Wage structure reflects our financial status and is similar to other museums in the area. Though lower than current OC living wage targets, OCHM staff wages have steadily increased since 2014. Employment in small museums such as OCHM provides staff with the opportunity to engage with museum practices and obtain skills that allow them to advance in future careers. Employees are able to work in an environment that fosters learning, curiosity, and connection with a community of stakeholders who are passionate about the goals and mission of our museum. At this time, the museum is two to three years from potentially closing. In order to increase staff pay, the Foundation would need to take additional funds from its reserves, which would be financially devastating. Agency Information 1/23/2018 12:14:22 PM r ' ? c, i 4 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget Is your agency currently receiving and /or requesting other (non -Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes /No) No If yes, please list below: Include all programs that have funding requests /awards /totals from Carrboro, Chapel Hill, and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY17 -18 Award FY18 -19 Request Source Ex: Affordable Rental Rehabilitation 0 $20,000 Carrboro - Affordable Housing Ex: Agency Administration $15,000 $15,000 Carrboro — Other Ex. Total $15,000 $35,000 Carrboro Total Funding *Add rows or attach additional page, if needed. ii. Submit your agency's budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues • Private Donations • Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) Agency Information 1/23/2018 12:14 :22 PM Page 13 of 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOME /etc.) • Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses iii. Does your agency budget show a Surplus or Deficit? Yes Is there a significant change? Yes; we stopped reporting the museum's use of supplemental reserve funding as revenue on our budgets to show more clearly the museum's dire financial state. iv. What is your agency's fiscal year? July 1, 2018 - June 30, 2019 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/23/2018 12:14:22 PM _ DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Historic Foundation of Hillsborough and Orange County AGENCY REVENUE Private Donations Agency Generated Revenue (fees) Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc.) Private Foundation Grants Other Revenue Total Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Agency Expenses SURPLUS /(DEFICIT) FOR PERIOD: 1 $ - 1 $ - 1 $ 13,5251 0 FY 2018 -19 Agency Budget Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ 4,417 $ 4,900 $ 5,145 5% $ 12,456 $ 18,000 $ 18,900 5% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 6,450 $ 8,199 $ 16,388 100% $ - $ - i $ - 0 $ 9,995 $ 12,000 $ 19,596 63% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 1,500.00 $ 3,500.00 $ 3,675 $ 0.05 $ 29,500 $ 20,290 $ - $ (1.00) $ $ 64,318 44,865 $ $ 66,889 44,090 $ $ 63,704 46,295 -50%16 5% $ 5,465 $ 6,571 $ 6,900 5% $ 3,418 $ 5,060 $ 5,313 5% $ 369 $ 200 $ 210 5% $ 10,201 $ 10,968 1 $ 11,516 1 5% $ 64,318 $ 66,889 1 $ 70,233 1 5% SURPLUS /(DEFICIT) FOR PERIOD: 1 $ - 1 $ - 1 $ 13,5251 0 FY 2018 -19 Agency Budget DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Education through Exhibits Program Primary Contact and Title: Stephanie Pryor, Interim Executive Director Telephone Number:(919) 732 -2201 E -Mail: director @orangenchistory.org a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety -net services for disadvantaged residents X Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods /Residents Affordable Housing Affordable Healthcare Education X X X X X Family Resources Jobs /Jobs Training Food Transportation Other: Please specify c) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. • The Orange County Historical Museum collaborates frequently with Free Spirit Freedom, an Orange County cultural arts initiative, promoting and supporting events and exhibits highlighting ethnic and social aspects of the culture and history of African - American, Native American and other traditionally marginalized communities. • This year is the WWI Centennial and the OCHM is collaborating with the Alliance for Historic Hillsborough and the Hillsborough Garden Club. • The museum currently recruits interns from various departments of N.C. State, UNC- Greensboro, UNC- Chapel Hill, Duke, and Elon University to encourage students to intern and volunteer at the Orange County Historical Museum and aid in the continued improvement of exhibits. We are working with three interns in the spring of 2018. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a PROGRAM INFORMATION 1/23/2018 12:14:22 PM��? DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Town /County priority /goal? The Orange County Historical Museum provides the community with a connection to their past by preserving the rich history of Orange County, one of the oldest counties in the state. We are the only historical museum in Orange County, and the only historical institution responsible for the preservation and interpretation of all of Orange County's history. The museum provides exhibits of its artifacts and information to the public free of charge. For both locals and tourists, a museum reflects the community it serves and rotating permanent exhibitions help keep it a vital and changing experience for visitors. The permanent exhibitions at the Orange County Historical Museum need updating. According to internal inventory records, objects on display have been so since at least 2015, leaving residents few reasons to return to the museum. Several of the exhibition panels currently on display at the museum were made over a decade ago. Bringing permanent exhibitions up -to -date will not only improve learner experiences, but it will also increase the museum's visitation numbers. The objects in the permanent exhibitions are also in needs of scheduled rotation for the safety of the objects. Many of the objects are fragile and the light levels are too high in the first -floor galleries for these artifacts to remain safely on display for extended periods. Enthusiasm for the arts in Orange County is undeniable. By collaborating with Orange County arts organizations, like the Hillsborough Arts Council and the Orange County Arts Commission, the OCHM aims to launch an open call for local artists to redesign our exhibitions. Other museums across the United States have used or currently use this approach, such as the Freedom Rider Museum in Montgomery, Alabama and the Maryland Historical Society. This approach would help diversify the museums audiences and help us create engaging learning experiences for the public The process of permanent collection reconceptualization, redesign and reinstallation allows museum staff to give voice to members of our community perhaps seldom heard and to reanimate objects in the light of contemporary issues. The OCHM aims to provide high - quality learning experiences through its exhibition program. We aspire to be a place that fuels creativity, ignites minds, and provides inspiration. In addition to our proposed work on the permanent exhibitions at the museum, we will have two temporary exhibitions in FY2018/2019. Our exhibition in March will feature women's clothing from WWI in celebration of Women's History Month. Our second temporary exhibition is a loan from the Wilson Library entitled, "Tobe: A Six - Year -Old Farmer." Tobe was one of the first children's books that aimed to feature realistic depictions of everyday African Americans. The museum is dedicated to helping the public engage with and enjoy our local history through a variety of exhibition venues that feature objects from the collection and we commonly loans material to other institutions for exhibitions. For example, in 2018, the OCHM will work with the Alliance for Historic Hillsborough on several loans for their WWI- inspired Living Room. Museum research consistently shows that some individuals prefer to visit museums digitally and many others may not have access to transportation to come to the museum. For patrons who are physically separated from the museums that they would like to visit, digital exhibitions provide opportunities for visitors to learn at their own convenience and in a place of their choosing. In 2018, we will provide a new online exhibition in our continued efforts to improve the digital accessibility of the museum. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council /Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human PROGRAM INFORMATION 1/23/2018 12:14:22 PM P �i e e 1 6 c, i C', DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Services Needs Assessment) to support the need for this program. In 2008, Orange County adopted its 2030 Comprehensive Plan. Chapter 6 of the 2030 Comprehensive Plan relates the goals and objectives of the county for its natural and cultural resources. The Orange County Historical Museum is eager to assist the County in reaching these objectives. This program addresses "Objective CR -6: Develop and strengthen educational programs to make history engaging to the public." The Orange County Historical Museum is the only historical museum in Orange County, and we provide exhibits of artifacts from our collection to teach the public about history. Museum exhibitions play a primary role in how the public learns about history. By publicly exhibiting artifacts from Orange County, the community learns about its shared but diverse past. Our museum has been around for over 60 years and we have an amazing collection of artifacts to share with the public. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Our target population is comprised of people likely to visit museums from around Orange County and the world, people interested in the subjects touched on by our exhibits, and people seeking educational and recreational opportunities. Our outreach to visitors includes social media, county public venues (web -based community calendars, for example) printed advertising materials, word of mouth, local news coverage and OCHM participation at a variety of special County events. Many of our visitors self- identify as being interested in museums and seek us out; others are reached through the methods described above. Exhibits are designed to appeal to visitors with varied interests, backgrounds, and education levels, and to engage and encourage their patronage of the museum. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Stephanie Pryor (Interim Executive Director) holds an MA degree and has extensive research and curatorial experience. She completed certificates in museum studies and non - profit management, has curated public exhibitions, published articles, and given public lectures in the US and abroad. The Interim Executive Director, Stephanie Pryor, in consultation with the HFHOC board of directors: • Plans and executes on -site temporary and permanent exhibits, utilizing museum collections and collections offered for temporary loans by community members. • Delivers the majority of exhibit tours and develops special events to support exhibits. • Guides and mentors interns working on exhibition projects. • Supervises the museum coordinator's work on social media and printed publicity to support exhibits and related events and helps deliver visitor tours. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Specific period: July 1, 2018 -June 30, 2019. The Orange County Historical Museum maintains a perpetual calendar of permanent and temporary exhibits throughout the year. From July 1, 2018 - June 30, 2019, we will be engaged in displaying permanent exhibitions and developing temporary exhibitions for our community of museum visitors. Additionally, the museum will: 1. Update three permanent exhibitions at the museum. 2. Organize and develop two temporary exhibitions a year at the OCHM. 3. Develop one online exhibition for the museum's website. PROGRAM INFORMATION 1/23/2018 12:14:22 PM Page 1 7 cu f 4 CC` DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) Museum exhibitions bring together residents and visitors and start conversations that break down mistrust, misinformation, and ignorance. Understanding the importance of our diverse but shared past provides context for a community to confront the past to make a better future. This mission gives the museum a unique power to strengthen citizenship values, build community pride, and improve quality of life. Museums are cultural institutions that are trusted places to discuss difficult issues. Museums allow visitors to meet with neighbors, discuss thoughts and opinions, and become an active part of the community. Research has uncovered that creating community involvement is more about location than the activity at hand, and this kind of location -based learning (like the kind utilized in museums) is a trigger for change and development within the community. The promotion of education and the conversation that are taking place in museums across the nation shape and strengthens our neighborhoods. As museums are functioning increasingly like community centers, they have become hot -spots for civic engagement. j. Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If future funding levels stay at present levels, the museum will close in two to three years. Beginning with the recession in 2008, the museum's expenditures outpaced its income. To meet community needs for free public programming and stay open, the museum has been drawing on its reserve funds. Over the past ten years the museum has augmented its operational budget by $129,482. At this time, the museum only has enough reserve funds for two to three years of operation before the museum will close, leaving Orange County with no historical museum dedicated to preserving and sharing the county's history with the public. Increased community support for the Orange County Historical Museum proves that individuals, businesses, and local organizations value the museum. Looking at FY2016 -17, there was an increase in public support through memberships, and, in FY2017 -18, OCHM staff and volunteer board have raised approximately $20,000 through memberships, donations, events, business sponsorships, and fundraisers. Without additional government and NGO support, we will be unable to continue to stay open and offer free public programs to the community. k. What percentage of your target population is low- moderate income? 100% All of our exhibitions are free and open to the public. I. What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) In the fall of 2017, the museum organized a community survey to understand what residents need from the museum. We received a lot feedback and are using this data to drive programming decisions. PROGRAM INFORMATION 1/23/2018 12:14:22 PM? DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION In the FY2018/2019, we will ask exhibition visitors to complete written evaluations for exhibitions we present, and, using social media, the staff plans to do audience research to gauge visitor expectations for upcoming exhibitions. This will guide exhibition design and improve visitor satisfaction. m. Include any other pertinent information. PROGRAM INFORMATION 1/23/2018 12:14:22 PM Page 19 of 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information n. Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics Gender Male Female Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total Of the above, how many Hispanic /Latino Of the above, how many non - Hispanic /Latino Total Age Geographic Location 0 -5 years 6 -18 years 19 -50 years 51 + years Total Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Actual Estimated Projected 2016 -17 2017 -18 2018 -19 1435 2696 2250 1435 2697 2250 3870 5393 5500 Total 1 *3870 1 *5393 1 *5500 PROGRAM INFORMATION 1/23/2018 12:14:22 PM Page 20 of 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION p. Program Budget 1. Submit your program budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues o Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOME /etc.) • Private Foundation Grants o Other Revenue Expenditures o Compensation o Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses 2. Program Budget Detail — Provide description of "other" budget items, not defined. To meet community programming needs and stay open, the museum is forced to draw on its reserve funds, which are running out. Over the past ten years the museum has augmented its operational budget by $129,482. Without additional government and NGO support, the museum only has enough funds for two to three years of operation before closing. 3. This program budget represents what percent of the agency budget? 30% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/23/2018 12:14:22 PM _ -' Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Total Cost of Program $20,713 $21,471 $21,556 Total # of Individuals 3870 5393 5500 Cost Per Individual $5.35 $3.98 $3.92 PROGRAM INFORMATION 1/23/2018 12:14:22 PM _ -' DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Outreach Education Program Primary Contact and Title: Stephanie Pryor, Interim Executive Director Telephone Number:(919) 732 -2201 E -Mail: director @orangenchistory.org a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety -net services for disadvantaged residents X Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods /Residents Affordable Housing Affordable Healthcare Education X X X X X Family Resources Jobs /Jobs Training Food Transportation Other: Please specify c) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. • For Hillsborough History Day field trips, we work with The Alliance for Historic Hillsborough and Burwell School. • For family workshops like Revolutionary War Living History ay, we collaborate with The Alliance for Historic Hillsborough. • For Last Friday Art Walk family workshop events we work with the Hillsborough Arts Council. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town /County priority /goal? PROGRAM INFORMATION 1/23/2018 12:14:22 PM =j a g e 2 3 cs i DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Our Outreach Education Program includes activities for K -12 students, families, and adults. We aim to touch all stages of life with our informal educational programs. The Orange County Historical Museum Outreach Education Program fulfils a county need of providing high - quality, inclusive educational experiences to children and adults in Orange County at no cost to participants. Heritage Education: The museum's Heritage Education Programs provide a free, positive, interactive learning experience focused on Orange County history to school children. Since the OCHM's first field trip in 1957, the museum has invested significantly in its Heritage Education Program, both at the museum and to Orange County Public Schools. The Foundation has reached over 15,000 students since 2008 in schools from all parts of Orange County. The Museum's Heritage Education programs are created for easy travel to the schools and provide children with educational enrichment otherwise denied by budget and time restraints. Using feedback from participants, the Museum has, and will continue to develop a diverse array of programs to help fill the needs of teachers, parents, and children. Traveling Trunk Program: This program is designed to offer an interactive experience enhanced with reproduction artifacts and informed by a detailed lesson plan, which supports NC's essential standards for students. A modest rental fee for the program insures it is accessible for a broad range of community users. Art at the Museum and Park: This program is aimed at children from at -risk and low- income households. Activities are geared toward children ages 5 -18 years. Held at the OCHM and Fairview Park in Hillsborough, this program allows children the opportunity to learn about the history of Orange County through hands -on art activities. Most recently, acclaimed artist Renzo Ortega has given bilingual, Spanish - English instruction in basic painting and drawing techniques and worked with students to create artwork inspired by folk art and objects from the museum's collection. History Fun Day: For the past 11 years, the OCHM, the Burwell School, and the Alliance for Historic Hillsborough have collaborated on History Fun Day in Hillsborough. The museum gives tours and leads hands -on activities with participating K -12 student groups. Tours, based on the history of Hillsborough and Orange County, are written and delivered to support and enrich Orange County K- 12 students' social studies learning. Education Special Events: The OCHM supports the Alliance for Historic Hillsborough's Living History Days with programs and activities designed for families with children. These include Revolutionary War Living History Day, Hillsborough Day, and Hillsborough Fourth of July events. We offer workshops and demonstrations designed to highlight Hillsborough's rich history. For example, in the past, we have presented a weaving workshop, highlighting the history of domestic textile production with an in- gallery demonstration weaving demonstration by a local artisan and a hands -on family weaving workshop. Lecture Series (New): A survey completed by the OCHM in 2017 found that community members were eager for adult lectures at the museum. Therefore, in 2018, the OCHM will host a lecture series at that is free and open to the public. This series supports the goal of the Orange County BOCC to foster life -long learning opportunities for residents of Orange County by bringing diverse voices to the area to discuss the history of Orange County and America. The museum has also applied to the North Carolina Humanities Council for assistance in bringing speakers to the museum. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. PROGRAM INFORMATION 1/23/2018 12:14:22 PM I71 a g e 2 4 cs o 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Council /Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. The Outreach Education Program at the OCHM addresses two community needs in Orange County. One of the recommendations in the Chapel Hill Human Services Needs Assessment is to provide "quality, equitable education for everyone." Field trips, special tours for students, family workshops, exhibits, and participation at the museum's Art in the Park/Museum Program provide students with quality learning experiences and are available at no cost to participants. The Orange County BOCC set as one of its goals to "ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare." For 60 years, the OCHM has been providing high - quality learning experiences. The OCHM develops educational events for adults and students that are consciously designed to be inclusive of all members of the diverse Orange County community. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The Heritage Education Programs target K -5 students. They are reached via correspondence and social media directed to educators. Users of the Traveling Trunk Program self- identify as interested learners. They come primarily from church and home school groups and community youth organizations. Special events participants are reached through social media, word of mouth, and printed and distributed advertising. They are identified and connected through their interest in community resources, specifically cultural activities. Our lecture series targets adult, life -long learners and persons interested in educational activities. They are reached through community events calendars, social media, OCHM's website, and printed and distributed advertising. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Stephanie Pryor (Interim Executive Director) has an MA and holds certificates in museum studies and non - profit management. She has recent training in museum education, assisted with museum activities, and taught college -level art history courses. The Interim Executive Director, Stephanie Pryor, in consultation with the HFHOC board of directors: • Acts as program director to plan and execute our Outreach Education Program • Develops and delivers family workshops • Develops and delivers regular Art at the Museum and Park programming • Organizes and delivers six lectures at the museum The Executive Director and education interns prepare all K -12 material (Heritage Education Program and History Fun Day). Education interns and volunteers may assist with preparing materials for and provide supervised assistance at educational program, but are not allowed to work unsupervised with students and children. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Specific period: July 1, 2018 -June 30, 2019. PROGRAM INFORMATION 1/23/2018 12:14:22 PM DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Implementation timeline: commencing July 1, 2017 and continuing through June 30, 2018, OCHM will: • The Museum's Heritage Education Program will travel and provide one of several program options to at least 9 school groups by Dec. 31st 2018, and an additional 9 school groups between January 2019 and June 30th 2019. • Participate in education programs with the Alliance for Historic Hillsborough and the Burwell School on Hillsborough History Days • Make traveling trunks available to community groups requesting them • Deliver regular family - friendly programming for Art at the Museum /Park Program • Deliver six lectures at the OCHM i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) The primary role of museums is to educate the community. Galleries are classrooms and museum exhibits inspire interest in an area of study, item, time period, or an idea. Museums are examples of informal learning environments and provide important educational services for county residents. One national -level study, which measured the economic impact of museums as part of the arts and cultural sector estimated the impact of the nonprofit arts sector at the national level at $66.2 billion each year.' Field trips are a common feature of public education in the United States. A recent study examined six years of student -level data from a large -scale program in New York City (approximately 200 schools per year). The study's author estimated the impact of field trip exposure on students' performance.' The author found positive effects of exposure to field trips on science test scores and proficiency. As the author notes, "These results are important for policy, as they demonstrate that enrichment and informal learning experiences can contribute positively to student achievement." Other studies on the impact of museum programs on achievement show the positive effects of museum visits on a young people's cognitive development and critical- thinking skills.' j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If we do not receive requested funding or receive a reduced allocation of funding, the OCHM would be forced to lessen the amount of outreach we do to the community and to assess which programs to cut in order to continue critical education programming. If future funding levels are not increased significantly, the museum will close in two to three years due to lack of financial support. We cannot continue to offer free programs to the community without additional governmental support. k) What percentage of your target population is low- moderate income? 100% 1) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) We will ask teachers, students, and community participates to complete written evaluations for programs we present. We also conduct an annual digital survey to guide program decisions. ' Americans for the Arts. 2007. Arts and Economic Prosperity III. Washington, DC: Americans for the Arts. 2 file: / / /C:/ Users /steph /AppData /Local /Temp/Working paper 03- 15 -1.pdf 3See for example, https : / /eric.ed.gov / ?id= EJ802612 PROGRAM INFORMATION 1/23/2018 12:14:22 PM Page 2 6 o p 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION m) Include any other pertinent information. PROGRAM INFORMATION 1/23/2018 12:14 :22 PM Page 27 of 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics Gender Male Female Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total Of the above, how many Hispanic /Latino Of the above, how many non - Hispanic /Latino Total Age Geographic Location 0 -5 years 6 -18 years 19 -50 years 51 + years Total Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Actual Estimated Projected 2016 -17 2017 -18 2018 -19 1124 916 1000 1124 917 1000 1248 1823 2000 147 300 335 948 1503 1660 1248 1823 0 801 1203 1325 300 320 340 1248 1823 2000 300 320 340 948 1503 1660 1248 1823 0 0 0 0 No data No data No data 354 376 430 46 62 70 848 1385 1500 PROGRAM INFORMATION 1/23/2018 12:14:22 PM Page 28 of 40 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION o. Program Budget 5. Submit your program budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues • Private Donations • Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOME /etc.) • Private Foundation Grants o Other Revenue Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses 6. Program Budget Detail — Provide description of "other" budget items, not defined. To meet community programming needs and stay open, the museum is forced to draw on its reserve funds, which are running out. Over the past ten years the museum has augmented its operational budget by $129,482. Without additional government and NGO support, the museum only has enough funds for two to three years of operation before closing. 7. This program budget represents what percent of the agency budget? 10.9% 8. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/23/2018 12:14:22 PM P a g e 30 cu i 4 Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Total Cost of Program $6,937 $7646 $7657 Total # of Individuals 1248 1823 2000 Cost Per Individual $5.55 $4.19 $3.83 PROGRAM INFORMATION 1/23/2018 12:14:22 PM P a g e 30 cu i 4 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Preservation and Research Program Primary Contact and Title: Stephanie Pryor, Interim Executive Director Telephone Number:(919) 732 -2201 E -Mail: director @orangenchistory.org p) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety -net services for disadvantaged residents X Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents q) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods /Residents Affordable Housing Affordable Healthcare Education X X X X X Family Resources Jobs /Jobs Training Food Transportation Other: Please specify r) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: s) Summarize the program services proposed and how the program will address a Town /County priority /goal? The Orange County Historical Museum (OCHM) is the only historical museum in Orange County, and the only historical institution responsible for the preservation of all of Orange County's history. The OCHM takes physical preventive care measures to prevent damage and delay the natural deterioration of the cultural heritage collection objects in its possession. We aim to provide PROGRAM INFORMATION 1/23/2018 12:14:22 PM �� o DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION enhanced safety for the collection and to limit damage from external sources such as improper handling, unstable environmental conditions, vandalism, and pests. OCHM staff monitor and ensure the safety of the museum's collection for future generations, accession and catalogue objects into the collection, maintain digital and analogue files of objects in its collection, and conduct inventories. In 2018, we will move the collection to a new storage area, which will provide improved conditions for the collection. OCHM staff will prepare objects for the move, and review records and the conditions of objects before and after the move. The museum's collection - preserved and shared in our archives and galleries - continues to be a powerful tool for engagement in Orange County history by our community through educational and recreational opportunities. These high quality, no cost programs are the experiences that both the town of Chapel Hill and the OC BOCC are eager to offer community members. Without continued collection and preservation efforts, the museum's ability to teach, exhibit, and inform our community will be significantly restricted. For six decades, the OCHM has been a useful resource to those conducting research on Orange County. We strive to discover and document the history of Orange County, to promote local historical awareness, relate it to everyday life, and share it with interested researchers. The museum offers access to its collection documents for those researching Hillsborough and Orange County history, for both individual and community projects. The OCHM provides supervised research access to archival and acquisition files and our digital database as well. Museum staff offer researchers assistance with specific requests and share any information held in the museum collections. Staff also offer resources, including referrals in the community, to other organizations that may have information relevant to individuals' projects. t) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council /Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. The OCHM's ability to fulfill the Town of Chapel Hill and OCBOC needs expressed in relation to the museum's mission and goals, including provision of learning and recreational opportunities, are predicated on the successful preservation and conservation of the collections we hold. All museum activities, projects, and programs, are connected to our mission to collect, preserve, and share those artifacts that tell the story of Orange County's diverse, deep, and rich history. u) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? 100% v) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Stephanie Pryor (Interim Executive Director) has a master's degree from Tufts University and a certificate in museum studies. She has taken coursework in conservation methods at MIT's Center PROGRAM INFORMATION 1/23/2018 12:14:22 PM o ��- DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION for Materials Research in Archaeology and Ethnology and has worked with collections in the US, Israel, and Italy, including at Pompeii. The Executive Director, acting as project manager, is directly responsible for OCHM's preservation and conservation policies and practices. The HFHOC board is responsible for all acquisition decisions. Initial review of artifacts is made by a special collections committee, of which the Executive Director is a member. Any final decision about artifact accession is made by the full HFHOC board. The Executive Director and Collections' Interns work together on managing the collection, giving local college students valuable work experience. w) Describe the specific period over which the activities will be carried out and include an implementation timeline. Implementation: July 1, 2018 -June 30, 2019. Our preservation and conservation activities are a part of daily routine in a perpetual cycle of caring for our collection. Collections activities are ongoing throughout the year, as OCHM staff responds promptly to community offers of donations. x) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) People, events, and objects from the past give a community its sense of identity and help tell its story. These resources are the most tangible reflections of a community's heritage. The recognition of an area's historic resources can bring about neighborhood revitalization, increased and sustainable tourism, economic development through private investment, and citizenship building. More than 4.8 billion artifacts are held in public trust by more than 30,000 archives, historical societies, libraries, museums, scientific research collections, and archaeological repositories in the in the United States. Sadly, a lack of public funding places a third of these items at risk of being lost. For example, our own current public facility is not adequate to preserve our fragile and priceless collection for future generations. For the museum to provide exhibits and educational programs and allow access to archival collections, we must have a collection that is properly preserved and conserved. The core mission of the museum is, and has been since 1957, to provide protection and care for treasured artifacts held in our collections for the enjoyment and education of the Orange County community and visitors around the world who come to visit the OCHM. y) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If we do not receive requested funding or receive a reduced allocation of funding, the museum would be forced to lessen the amount of research requests we fill and to assess which programs to cut in order to continue critical preservation of objects. z) What percentage of your target population is low- moderate income? 100% aa) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) bb) Include any other pertinent information. PROGRAM INFORMATION 1/23/2018 12:14:22 PM 3 3 , o A ,�� DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information cc) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics Gender Male Female Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total Actual Estimated Projected 2016 -17 2017 -18 2018 -19 13 15 17 14 15 18 27 30 35 0 0 0 Of the above, how many Hispanic /Latino Of the above, how many non - Hispanic /Latino Total 0 0 0 Age 0 -5 years 6 -18 years 19 -50 years 51 + years Total Geographic Location Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) PROGRAM INFORMATION 1/23/2018 12:14:22 PM 0 0 0 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement Chart for Programs Historic Foundation of Hillsborough and Orange County - Orange County Historical Museum 1. Program Activity Name Education through Exhibits Program Goal Deliver exhibit programming to 6500 visitors Performance Measures Will track the number of museum visitors Previous Year Program Results Fell short of our 2017 goal but we improved from 2016 Current Year Estimated Results 5393 Next Year Projected Results 5500 Program Activity Name Outreach Education Program Goal Deliver programming to 2600 OC school age children and families Performance Measures Will track the number of students served Previous Year Program Results Fell short of our 2017 goal but we improved from 2016. Current Year Estimated Results 1823 Next Year Projected Results 2000 Program Activity Name Preservation and Research Program Goal Will serve 30 researchers Performance Measures Will track the number of researchers served Previous Year Program Results Reached goal from last year Current Year Estimated Results 30 Next Year Projected Results 45 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION ee) Program Budget 9. Submit your program budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues o Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOME /etc.) • Private Foundation Grants o Other Revenue Expenditures o Compensation o Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses 10. Program Budget Detail — Provide description of "other" budget items, not defined. 11. This program budget represents what percent of the agency budget? 9.6% 12. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/23/2018 12:14:22 PM Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Total Cost of Program $6701 $6771 $6771 Total # of Individuals 27 30 35 Cost Per Individual $248.18 $225.70 $193.45 PROGRAM INFORMATION 1/23/2018 12:14:22 PM DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION PROGRAM NAME PROGRAM REVENUE Private Donations Program Budget Operating Budget for Program Preservation and Research Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc.) Private Foundation Grants Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Program Expenses SURPLUS /(DEFICIT) FOR PERIOD: FY 2018 -19 Program Budget $ - 1 $ - 1 $ - 1 0 Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ - $ - $ - 0 $ 2,000 $ 2,000 $ - -100% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 1,100 $ 1,449 $ 388 -73% $ - 1 $ - 1 $ - 0 $ 1,995 $ 1,000 $ 6,383 538% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 - $ - $ - 0 t$M1,576 $ 2,322 $ - $ (1.00) $ 6,671 $6,371 $ $ 6,771 6,371 $ $ 6,771 6,371 0% 0% $ - $ - $ - 0 $ 330 $ 400 $ 400 0% $ - $ - $ - 0 $ - $ - $ - 0 $ 6,671 $ 6,771 $ 6,771 0% $ - 1 $ - 1 $ - 1 0 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc.) Private Foundation Grants Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Program Expenses SURPLUS /(DEFICIT) FOR PERIOD: FY 2018 -19 Program Budget Outreach Education $ - 1 $ - 1 $ - 1 0 Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ - $ - $ - 0 $ 1,587 $ 896 $ - -100% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 2,350 $ 3,750 $ 4,000 7% $ - 1 $ - 1 $ - 0 $ 3,000 $ 3,000 $ 3,657 22% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ $ 6,937 5,423 $ $ 7,646 5,423 $ $ 7,657 5,423 0% 0% $ - $ - $ - 0 $ 1,514 $ 2,223 $ 2,234 0% $ - $ - $ - 0 $ - $ - $ - 0 $ 6,937 $ 7,646 $ 7,657 01 $ - 1 $ - 1 $ - 1 0 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME Education through Exhibitions PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc.) Private Foundation Grants Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Program Expenses SURPLUS /(DEFICIT) FOR PERIOD: 1 $ - 1 $ - 1 $ - 1 0 FY 2018 -19 Program Budget Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ - $ - $ - 0 $ 8,000 $ 8,000 $ - -100% $ - $ - $ - 0 $ - $ - $ - 0 $ - 0 $ - $ - $ - 0 $ 3,000 $ 3,000 $ 12,000 300% $ - 1 $ - 1 $ - 1 0 $ 5,000 $ 8,000 $ 9,556 19% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - 0 $ 4,713 $ 2,417 $ - $ (1.00) $ $ 20,713 19,771 $ $ 21,417 19,771 $ $ 21,556 19,771 1% 0% $ - $ - $ - 0 $ 942 $ 1,700 $ 2,200 29% $ - $ - $ - 0 $ - $ - $ - 0 $ 20,713 $ 21,417 $ 21,556 1% SURPLUS /(DEFICIT) FOR PERIOD: 1 $ - 1 $ - 1 $ - 1 0 FY 2018 -19 Program Budget DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C 151:4: I 1111"Iu Scope of Services — FY 2018 -19 Outside Agency Performance Agreement Agency Name: Historical Foundation of Hillsborough and Orange County Program Name: Education through exhibitions; Outreach Education; Preservation and Research Funding Award: $9.606 Outline how the agency will spend Orange County's funding award. Expense Description Amount Partial salary expenses for Executive Director $9,606 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Provide free life -long learning programs for the public: • Evening lectures and other events • Exhibitions for the community ■ Currently showing: • Women of Orange - July 20, 2018- January 20, 2019 • Memories and War: Stereographs of WWI -April 23, 2018 — November 15, 2018 • Provide free K -4 learning opportunity to school - groups. • Teach the public about local and regional history. • Fulfil research requests and assist with public access to the museum's collection. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons /units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Will track number of visitors served 5000 Will track number of students served 1600 Will track number of research requests filled 40 ShDOCUSigned by: ,, f L P yl +w executive director Certified by: 2AC3F9cE31E241F... _ Title: Date: (Provider's Signature) 8/16/2018 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C ATTACHMENT "A" Orange County Certifications — FY 2018 -19 Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DoCU Sig ned hy: Certified by: _ 2AC3F9CE31E241F... (Provider's Signature) Title: executive director Date: 8/16/2018 (Historical Foundation of Hillsborough and Orange County) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C Page 1 of 1 Erie CERTIFICATE OOIYY) OF INSURANCE DATE ISSUED(MMI ) 1119/ 18 / � lnsurana:^ —THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY — Home Office - 100 Erie Insurance Place - Erie, Pennsylvania 16530 • 814.870.2000 Toll free 1.800.458.0811 • Fax 81070.3126 • www.erieinsurance.com NAME AND ADDRESS OF AGENCY THE BALLARD AGENCY AGENT'S N0. GE 105 W KING ST � i,l 1010 • v - _ moo.. d _E8tORS JRANNGETROOMURTY_ &CAS. Ty HILLSBOROUGH, NC 27278 -2543 Co.: E ERIE INSURANCE EXCHANGE• of App ica e Ene Indemnity- Ca�Attorney in Fact I N RIE INSURANC 0— PANY -OF N Ma (919 )732 -2158 This certificate is issued for information purposes only and confers no rights on the certificate holder, It does not affirmatively or NAME AND ADDRESS OF NAMED INSURED negatively amend, extend, or otherwise alter the terms, exclusions Historical Foundation of and conditions of insurance coverage contained in the poiicy(ies) indicated below. The terms and conditions of the poHcy(ies) govern Hillsborough &Oran e Co Inc the insurance coverage as applied to any given situation. Limits 201 N Churton St shown may have been reduced by claims paid. This certificate of insurance does not constitute a contract between the issuing Hillsborough, NC 27278 insurer(s), authorized representative or producer and the certificate holder. This Is to certify that policies, as Indicated btjqePolic Number below, are in force for Named Insured at the time that the Certificate is being Issued. EthTTeI d i q POLICY NUMBERiMQ1Y. ATEylAthht� LIMITS TYPE QF INSURANCE E GENERAL LIABILITY Q44 2250193 8122117 8122118 EACH OCCURRENCE 1 000,000 ® COMMERCIAL GENERAL LIABILITY FIRE DAMAGE Any One Fire ) $ 1.000,000 ❑ CLAIMS MADE ❑ OCCUR MED EXP (Any One Person , 5,000 ❑ PERSONAL & ADV. INJURY S 1.000.000 ❑ GENERAL AGGREGATE 2,000,000 GENT AGGREGATE LIMIT APPLIESPER PRODUCTS- COMPIOPAGG 5 2.000,000 POLICY ❑ PROJECT ❑ LOC ❑ AUTOMOBILE LIABILITY BODILY INJURY EACH PERSON) S ❑ "ANYAUTO" (OWNED 1 HIRE " ❑ OWNED ACHLACCIDENT $ ❑ HIRED PROPERTY DAMAGE S ❑ NON -OWNED BODILY INJURY AND PROPERTY DAMAGE ❑ GARAGE COMBINED $ �] EXCESS LIABILITY EACH OCCURRENCE S ❑ OCCURRENCE AGGREGATE S I �S ❑ RETENTION S S L WORKERS COMPENSATION & Q92 2200217 5%2'2 17 SMUTORY N!21 i 1 ACCIDENT S 300.000 EACH ACCIDENT EMPLOYERS LIABILITY BODILY INJURY, DISEASE S 500.000 POLICY LIMIT I BY DISEASE S 500.000 EACH EMPLOYEE OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIV- ERED IN ACCORDANCE WITH THE POLICY PROVISIONS, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). NAME AND ADDRESS OF CERTIFICATE HOLDER � ESENTATIVE Orange County AUTHORIZEOREP P O Box 8181 Hillsborough, NC 27278 Page 1 of 1 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C DLARATLONS Erie !/34- ERIE INSURANCE EXCHANGE lnsuranc4 ULTRAFLEN POLICY :tir-.EA ,war��ca RENEWAL CERTIFICATE - COINSURANCE CONTRACT F-- &k �A u�x Agent 331010 THE RAL LAND AGENCY ITEM 1. Named Insured and Address THE HISTORICAL FOUNUTION OF $ ENDT #1 201 N CHURTON 5T HILLSOOROUGH NC 27278-2535 ITEM 2. Policy Period Pa.] icy Number 08122Y17 TO 09/22113 Q44 .2250193 NC ITEM 3- Other Interest POLICY PERIOD BEGIhS AND ENDS AT 12.01 A,M, STANDARD TIME AT THE STATED ADDRESS OF THE NAMED I NSU R L D . THE INSURANCE ,APPLIES TO THOSE PREMISES DESCRIBED AS PER THE ATTA(HLD 5UPPLEKENTAL DECLARATIONS- THIS IS SUBIECT TO ALL APPLICABLE TERMS OF THE POLICY AND ATTACHED FORMS AND ENDORSEMENTS DEDUCTIBLE (PROPtR.TY PROTECTION EMILY)- 200. COVERAl5ES: DEPOSIT PROPERTY" PROTECTION - A$ PER THE ATTACHED SUPPLEMENTAL DECL411kATIONS PREMIUM 1. BUILDINGS 2. BUSINE$$ PERSONAL PROVERTY AND PERSONAL RROPERTY OF OTHERS 1 N C L 3. INCOMIE PROTECTION A. GLASS AND LETT E R XNG � 5. SI6N5, LIGHTS AND CLOCKS LIMITS OF INSURANCE I NBC L FACH OCCURRENCE LIMIT DAMAf3 E TO PREMISES R E NTF [1 TO YOU LIMIT MEDICAL EXPENSE LIMIT S,OO PERSONAL & ADVER71SINI IN)UR.Y LIMIT 1,000,000 GIN€ RAL AG6R E GATE L IMF T PRODUCTS/COMPLETED OPERATIONS AG,GREGATL LIMIT OPT IO,NA L COVERAGES ANY ONE PREMISES ANY ONE PERSON ANY ONE PERSON OR ORGANIZATION SEE NEXT PAGE TOTAL DEPOSIT PREMIUM - - - - $ :25. APPLICAELE FORMS - SEE SCHEDULE OF FIRMS. See Reverse Side NKE 061115/17 «Sign Envelope ID: 8FFC qD9 aAF 64c &gG$AC 9D 9e +c OPTIONAL COVERAGES FINE ARTS FLOATER ELECTRONIC DATA PROCES5ING ENDORSEMENT Q44 2250193 CONTINUED ON NEXT PAGE ON14r -!W $ INCL $ IN£t DocuSign Envelope ID: 8FFCF3D9- 3AF5- 4C83 -9 982_9- AC9D49_75107_C_ -J9 EMPLOYERS LIAOUTY INSURANCE POLICY 1A 00 00 01A Erie INCLU ®ES CDP'fFMGWf MAT €f rLL FHE NATIONAL CIxUNCiL DR COMPENSATION INSURA CE. usC7 ' ini I T $ PF w1swN Insuarce' INFQRMATIOM PAGE x'74 arc; -•+.a,�' ° =i += :e. +_ '� , �, R PRIOR POLICY NUMBER. - Q92 2200715 Agent Insurance Is Provided By Po I i cy Num ber ' a: J31010 THE B I I ARD AGENCY ERIE INSURANCL EXCHANGE 18457 Q9.2 2100215 ITEM 1. Named Insured 2nd Address THE HISTORICAE FOUNDATION OF HZ l- L.!5B1)P()UGH & ORANGE CTY INC 201 N CHURTON ST HILLSBOROUGH NC 272' 78-2535 AMENDMENT 02 *4* EFFECTIVE R$ /, /17 REASON FOR AMENDMENT- AMENDED REMUN CORPORATION ORANGE CO OTHER WORKPLACES NOT SHOWN ABOVE - * ** ATTACH THIS TO Y04JE POLICY DUE TO AUDIT` AS SCHEDULED ITEM Z. THE POLICY PERIOD IS FROMM G312 X17 TO 08/22118 AT THE INSUREDS MAILING ADDRESS- ITFM 3.A. WORKERS COYIPENSATION INSURANCE- PART ONE OF THE POLICY APPLIES TO THE WORKERS COMPENSATION LAW OF THE STATES LISTED !HERE- NC, ITEM 3 -B_ EMPLOYLR5 LIAPILIT'Y INSURANCE- PART TWO OF THE POLICY APPLIES TO WORK IN EA(H STATE LISTED IN ITEM 3-A. THE LIMITS OF OUR LIABILITY UNDER PART TWO ARE- BODILY INDURY BY ACCIDENT $1,000,000 EACH ACCIDLNT BODILY IN3URY BY DISEASE $1,0$0,000 POLICY LIMIT BODILY INJURY BY DISEASE $1,000,000 EACH EMPLOYEE TTEM 3,C, OTHER STATES INSURANCE- PART THREE OF THE POLICY APPLIES TO THE STATE5, IF ANY, LISTED MERE- ALL STATES EXCEPT ND, CH, WA, WY, STATES DESIGNATED IN ITEM 3.A., ITEM 3,0,. SEE ATTACHED ENDORSEMENT SCHEDULE. ITEM 4. THE PREMIUM FOR THIS POLICY WILL BE DETERMINE[i UY OUR MANUALS OF RULES, CLASSIFICATIONS, RATES AND RATING PLANS. ALL INFORMATION R E QUI RED BELOW IS SUBJECT TO VFAIPTCATTON AND CKAN-GE BY .AUDIT_ SEE A7TACHED SCHEDULE OF OPERATIONS 9312 PREMIUM FOR IJNCREASED COV TWO LIMITS 10110 9343 AMT FOR INE R EA5 EU COV TWO NINE PREMIUM CODE 0990 AMOUNT TO SATISFY POLICY MIN PREMIUM EXPENSE CONSTANT TOTAL ESTIMATED ANNUM_ PREMIUM DEP05IT PREMIUM CHANGE IN PREMIUM FOR REMAINDER OF POLICY PERIOD MINIMUM (PREMIUM $643 RETURNED PAYMENT FEES WILL BE ADDED TO YOUR ACCOUNT.. PAGE 01 HOME OFFICE 02/22/18 SEE REVERSE SXDE DEC 68 1 119 425 160 ►773 $7'7 $010.0 DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C ** S C H E D U L E O F 0 P E ;R A 3 I 0 N 5 u* ITEM 43 CLASSIFICATIONS PREM 8A:S1S DATE EST ST L[)r- CODE TOIAL -E5T PER $100 ANNUAL N0 ANN REMUN REMUN PREMIUM NC 001 * *** CLASS 8810 CHANGED EFF 08/22117 $810 PUBLIC LIBRARY OR MUSEUM - 42,533 .14 $58 PROFESSIONAL tMPLOYEES AND CLERICAL 9015 BIJ T I D N (35 - OPERATION BY OWNER, IF ANY x . 22 LLS EE OR REAL ESTATE MANAGEMENT FIRM - ALL OTHER EMPLOYEES SUB -TO7AL 58 0741a TERRORISM , 014. +5 9741 CATASTROPHE (OTHER THAN CEIRTIFIED ACTS .010 4 OF TERRORISM) TOTAL FO =R NORTH CAROLINA $69 TOTAL SCHEDULE OF OP E RATIOS PREMIUM, $6.8 * * SCHEDULE OF PRIMARY AND ADDITIONAL LOCATIONS * * LOC 001 2131 N CHURTON ST, HILLSBOROUGH, NC .27278 :k* E N D O R S E M E N T S C H E D U L E '* THIS VOLICY INCLUDES THESE ENDOR$EMENTS AND SCHEDULES- "dC- (1/15, WC- UF4912 (NC), WC- e00414 (NC), WC- UF4839 (NCB, WC-000419 (NC), WC- 00ID421D (NC), WC-13004228 (NC), WC- 3203O1C {rr-)3 WC- UF5215 (NC), WC- UFO143 (N-C), WC-ODO°DODC (MC), W(7- UFB213 (NC), WC- UFB900 (Nr-), WC- UF4802 (K), IBC- 000424 (NC), WC- 000425 (MC). 0 C Q9 2IS - DocuSign Envelope ID: 8FFCF3D9- 3AF5- 4C83 -9 982_9_- AC9D49_75107_C .�0 EMPLOYERS LIABILITY INSURANCE POLICY WC DO 09 01A Erie INCLUDES CDF'YRICEii MATEMIL OF ilk 103CINRL COUNCIL CONY ERSATIDN INSURMCF. USED wan 1 I's PEFIK15Z1% /04- n E74.DM l'3U'jx0:7S_a FINAL AUDIT STATEMENT hm P.4 ith ll Agent Insurance to Provided By P-0I icy dumber �"':° J31010 THE BALLARD A6ENI;Y ERIE INSURANCE EXCHANGL' 18457 Q92 2200215 ITE -M 1. Named Insured and Address THE HISTORICAL FOUNDAT TON OF HILLSBOf{OOGI -11 & ORANGE CTY INC 2 -01 N CHURTON ST HILLSBR}ROUGH ]NC 27275 -2535 WHEN THIS POLICY WAS ISSUED, THE PREM -XUM WAS aASED ON AN 'ESTIMIATED' P'AYR01L. RECENTLY, WE RECEIVED AN AUDIT WH M1 CAVE US THE 'ACTUAL' PAYFROL L . RE LOW WE SHOW THE INFORMATION FROM THE AUDIT AND HIE ! N V ICATE :' - E 'ACTUAL ' PREMIUM A1.40 THE 'ESTIMATED' PREMIUM AND NOW THE 'CHANGE IN PREMIUM' AFFECTS YOUR ACCOUNT. AUDIT PERIOD 08/22116 TO GS/ 22, 17 ST LOC CODE CLA5SIFICATIOPIS AUDITED RATE NU PAYROLL PER 1$$ PAEMIUM SEE ATTACHED SCHEDULE OF OPERATIONS 85 0990 AMOUNY 1'0 SATISFY POLICY MIN PREMIU °M 265 EXPENSE CONSTANT 16e ACTUAL PREMIUM 51$ ESTIMATED P REM!9M 797 CHANCE IN PREMIUM DUE TO AUDIT $277 CFR RETURNED PAYMENT FEES WILL BE ADDED TO FOUR ACCOUNT_ PAGE 01 HOME OFFICE 02/22119 SERE REVERSE SIDE DEC DocuSign Envelope ID: 8FFCF3D9- 3AF5 -4C83- 9829- AC9D4975107C ST LOC CODE CLASSIIFICATIONS AUDITED RATE ly 0 PAYROLL PER $1,00 PREM!, .I NC 0$1 8810 PUBLIC LIBRARY OR MUSEUM - 41,!;S3 .13 $75 PROFESSIONAL EMPLOYEES AND CLERICAL 91015 BUILDINGS - OPERAtTION BY 014NLR., NIL 4.11 $ LESSEE OR REAL ESTATE MANAGEMENT FIRM - ALL OTHER EMPLOYEES SlUa -TOTAL 75 9740 TERRORISM . -014 6 9741 CATASTROPHE (OTHER T"A,N CERTIFIED ACTS . 01.0 4 OF TERRORISPI TOTAL FOR NORTH CAROLINAS sg5 $85 Q92 2200215 5.�i d0,2